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Psychiatry > DSH, suicide and risk assessment > Flashcards

DSH, suicide and risk assessment Flashcards

1
Q

How many people die every year worldwide due to suicide?

A

800,000

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2
Q

Does everyone who self harms have a psychiatric illness?

A

No; only a small percentage

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3
Q

Does everyone who commits suicide have a psychiatric illness?

A

No; but the majority

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4
Q

Which gender is more susceptible to suicide?

A

Men

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5
Q

Which methods do men and women respectively tend to favour in suicide attempts?

A

Men; hanging

Women; posioning

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6
Q

Which season has the highest and lowest rates of suicide respectively?

A 
Spring = highest
Autumn = lowest
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7
Q

Which professions have the highest rates of suicide?

A 
Unskilled workers
Construction workers
Doctors
Dentists
Farmers
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8
Q

Which specialities of medicine have the highest rates of suicide?

A

GP
Anaesthetists
Psychiatrists
Public health doctors

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9
Q

Who is most at risk in the US if there is a gun in the house?

A

Yourself

83% of domestic gun fatalities are due to suicide

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10
Q

What physical illnesses confer the highest rate of suicide?

A

Neurodegenerative diseases

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11
Q

Which neurotransmitter has been seen to be lower in the CSF of those with a history of DSH?

A

Serotonin

Reduced binding to 5-HT transported sites in the ventral prefrontal cortex

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12
Q

Can you see anything on neuroimaging of those who show high lethality DSH than those who show low lethality DSH?

A

High lethality; reduced prefrontal cortex activity

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13
Q

Is there a relationship between suicide and genetics?

A

MZ twins have a 13.2% concordance rate

DZ twins have a 0.7% concordance rate

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14
Q

Does the media have an impact on suicides?

A

YES
If a media outlet reports on a suicide, tells in detail the method and the difficulties the person faced, suicide rates will increase

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15
Q

Is there a link between cigarette smoking and suicide?

A

Yes, increases risk

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16
Q

Link between cholesterol and DSH/ suicide?

A

Lower levels of cholesterol confer a higher risk of DSH/ suicide

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17
Q

What is the single strongest risk factor for suicide?

A

History of DSH; risk of suicide in 12 months after DSH is 1%

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18
Q

Who is more at risk of suicide post DSH?

A 
Older
Male
Unemployed or retired
Single, separated or divorced
Isolated
Poor health
Psych history 
Violent DSH
Suicide note
History of DSH
19
Q

What people are more likely to develop chronic self harm?

A 
Previous DSH
Personality disorder
Alcohol or other drug abuse
Previous psych history
Unemployed
Low socio-economic group
Criminal record
25-54 years of age
Single, separated, divorced
20
Q

What is hopelessness a good indicator of?

A

Eventual fatal self harm

21
Q

Management of a suicidal patient

A 
Calm patient
Crying yes; aggression no. Be supportive but firm
Direct the interview
Provide privacy
Distract the patient
Deep breathing
22
Q

Good ways to phrase questions around suicide?

A

“I realise things have been really bad; has it ever got so bad you thought life wasn’t worth living?”
“How close have you come/ What stopped you?”
“What might help you stop getting to that point again?”
“what are things that would help you keep going?”

23
Q

What is important to elicit when speaking to a suicidal patient or someone who has self harmed?

A

Antecedents
Episode of self harm
Mental state then and now

24
Q

What is the more long term management of DSH/ suicidal ideation/intention?

A

Bolster self-esteem and problem solving
Discuss personal matters with a stranger takes bravery
Any relief from discussing probelms indiactesthey may discuss things again
Look for past episodes when they have solved problems
Use family/ friends
Safety plan; Suicide?Help! App

25
Q

What organisations can be helpful to signpost patient to and involved in their care?

A 
Psychiatry/ psychology
CPN
Counselling: cruse, rape crisis, womens refuge
Social work
Addictions
Samaritans
26
Q

What language is helpful to use when describing patients will suicidal intent?

A

Passive death with
Suicidal ideation vs suicidal intention
Mild/ mod/ severe
Fleeting/ intermittent/ constant

27
Q

Purpose of a suicide risk assessment?

A

Establish patients intent
Assess seriousness and perceived seriousness of attempt
Assess how they feel about the attempts

28
Q

How can you establish intent?

A

Start of with the day in question and obtain a narrative/ autobiographical timeline of what happened
Use open questions and then later use closed questions

29
Q

What are key points to establish about the current episode of self harm?

A

Before
During
After

30
Q

What should be asked when talking about before the episode of self-harm?

A

Was there a precipitant
Was it planned, or impulsive?
Did the patient carry out any final acts (suicide note, leaving a will, terminating contract e.g. mobile phone, gas and electricity)
Any precautions taken against discovery? e.g. closing curtains, locking doors, going somewhere remote
Was alcohol used?

31
Q

What is important to elicit about what happened during the episode of self harm?

A 
What method
Were they alone?
Where were they?
What went through their mind
Did they think the self harm would kill them
What did they do straight after?
32
Q

What is important to elicit about what happened after the episode of self harm?

A

Did the patient call anyone? How did they get to A+E? Who were they found by?
How did they feel when help arrived?
How do they feel about the attempt now? Do they regret it?
What is the patients current mood?
Do they still feel suicidal?
If they were to go home today, what would they do?
If they were to feel the same again, what would they do differently?
Any protective factors?
Will they accept treatment?

33
Q

Specific questions about overdose?

A 
What meds?
Where did you get them from?
How many?
What did you take them with?
What did you think it would do?
What made you decide to take them?
How long haev you been thinking about taking an overdose?
What did you do after?
How did you get to the hospital?
34
Q

Specific questions about cutting

A

Where are the cuts?
Number of cuts?
How deep?
Can you describe how you felt whilst cutting?
How did you feel when you saw the blood?
What were you hoping the cutting would do?

35
Q

How to screen for depression?

A

Check for cardinal symptoms; anhedonia, low mood, anergia

36
Q

How to screen for psychosis?

A

Are the thoughts to harm ever not your own
Do you ever feel like there are voices that you can hear telling you to harm yourself
If YES; how to they know the voices are not their own worries in their head?

37
Q

What co-existing psychiatric conditions should you screen for in a suicide risk assessment?

A

Depression
Psychosis
Alcohol dependency
Anorexia

38
Q

What should you enquire about in past medical history?

A

Previous episodes of self harm (what methods, any professional help)
Any psychiatric diagnosis or admissions to psychiatric hospitals
Medical conditions (any chronic pain or illnesses that increase risk of suicide)

39
Q

What should be asked in social history when assessing suicide risk?

A

Living situation; who is at home, where, good support network, able to manage activities of daily living
CHILDREN; are they being neglected, are they witnessing the episodes, any thoughts of harm towards the children
Occupation (are they coping financially)
Alcohol
Recreational drugs

40
Q

What is a good example of a saftey plan?

A

Support of family friends
Recognise stressors
Avoid harmful alcohol use when stressed
If they feel like that again who can they tell?
Suggest: use support network, GP, phone local support line, present to A+E before overdose, contact local mental health services

41
Q

What are appropriate agencies to signpost to?

A 
GP
Housing services
Citizen's Advice Bureau 
Alcohol and Drugs services
Domestic Violence Services
Counselling Services
42
Q

Demographics that increase the suicide risk?

A 
Male
Older
Widowed/ separated/ single
Living alone/ social isolation 
Low income/ unemployed
Certain occupation e.g. doctor, farmer
Family history of suicide
43
Q

What characteristics of the self harm itself point towards a high risk of suicide?

A 
Final acts
Researching of methods, preparation 
High perceived lethality
Precautions against being found
Violent methods
Patient discovered by change
Patient resists/ tried to evade medical intervention 
Downplaying of seriousness

Psychiatry (35 decks)

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